CHESTGuidelines & Topic CollectionsCOVID-19 Resource CenterClinical Resources

COVID-19 Clinical Resources

These expert-vetted articles and infographics provide guidance on the clinical management of COVID-19 patients, ICU administration, procedures, supply chain issues, and treatment. Listed below are some of the highlights found within each section.

FEATURED RESOURCES

Post-Intubation Tracheal Stenosis (PITS)

Published June 10, 2022

Postintubation tracheal stenosis is increasingly recognized in survivors of severe COVID-19.

View the Infographic »

Cerebrovascular Complications of COVID-19

Published April 15, 2022

Overview of types of stroke in COVID-19, including mechanisms, risk factors, characteristics, and outcomes

View the Infographic »

Post-Intensive Care Syndrome infographic icon

COVID-19-Associated Fungal Disease

Published March 16, 2022

Overview of COVID-19-associated pulmonary aspergillosis, including diagnostic criteria, incidence, risk factors, and treatment.

View the Infographic »

Nonpharmacological Prevention and Management Strategies for Delirium

Published February 15, 2022

Nonpharmacologic interventions are often simpler and safer than medications.

View the Infographic »

Effectiveness of Face Mask or Respirator Use

Published February 4, 2022

This research from the CDC shows the effectiveness of face mask or respirator use in indoor public settings for prevention of SARS-CoV-2 infection.

View the report »

Anti-SARS-CoV-2 Monoclonal Antibodies

Published December 6, 2021

Understand indications, mechanisms of action, and NIH guidelines for this therapy.
Supported by Regeneron

View the Infographic »

ALL RESOURCES

Clinical Management

Post-Intubation Tracheal Stenosis (PITS)

Published June 10, 2022
Postintubation tracheal stenosis (PITS) is increasingly recognized in survivors of severe COVID-19, often weeks to months after discharge. It may be misdiagnosed as asthma or a COPD exacerbation.

View the infographic

Cerebrovascular Complications of COVID-19

Published April 15, 2022
Strokes in patients with COVID-19 may have worse outcomes than non-COVID-19-related strokes. Get a quick overview of types of stroke, including mechanisms, risk factors, characteristics, and outcomes.

Download and print (PDF)

Cerebrovascular Complications of COVID-19 infographic — Click image to view larger

COVID-19-Associated Fungal Disease

Published March 16, 2022
Since the global spread of COVID-19, reports of secondary infections with fungal organisms, particularly Aspergillus spp., have emerged. Get a quick overview of COVID-19-associated fungal disease, including diagnostic criteria, incidence, risk factors, and treatment for COVID-19-associated pulmonary aspergillosis (CAPA).

Download and print (PDF)

COVID-19-Associated Fungal Disease infographic — Click image to view larger

Nontuberculous Mycobacterial Pulmonary Disease (NTM-PD)

Published October 13, 2021
Nontuberculous mycobacterial pulmonary disease is becoming increasingly prevalent in the United States and in many places in the world and is a potential post-COVID-19 complication. Understand how to recognize and diagnose it, as well as the basic tenets of treatment.

Download and print (PDF)

Nontuberculous Mycobacterial Pulmonary Disease (NTM-PD) infographic — Click image to view larger

Post-Intensive Care Syndrome (PICS)

Published July 30, 2021
Survivors of critical illness, such as COVID-19, can suffer from new or worsening impairments in the physical, cognitive, or behavioral domains. These unintended consequences of critical care are referred to as PICS.

Download and print (PDF)

Post-intensive care syndrome (PICS) infographic — Click image to view larger

Different Types of COVID-19 Vaccines

Updated July 28, 2021
There are several types of vaccines currently in use or under development for COVID-19, each with different strengths, weaknesses, and efficacy against viral variants.

Download and print (PDF)

Acute Kidney Injury infographic — Click image to view larger

Safety and Efficacy of COVID-19 Vaccines in Patients With Complex Medical Comorbidities

Published June 7, 2020
Understand the data on the safety and efficacy of the COVID-19 vaccines in patient populations of interest to pulmonary and critical care medicine.

Asthma and COVID-19

Published May 17, 2021
Is there a connection between asthma and risk of COVID-19 infection? Find out the answer—and more—in this infographic from CHEST's Airways Disorders Network.

Download and print (PDF)

Asthma and COVID-19 infographic — Click image to view larger

Ambulatory ECMO for Respiratory Support in a Patient with COVID-19 Disease

Published May 11, 2020
The authors describe a case of ambulatory VV-ECMO in an adult with SARS-CoV-2-induced ARDS. The patient was weaned from the ventilator while still on VV-ECMO, allowing for early mobilization and participation in physical therapy.

Oxygen Conservation Strategies During COVID-19 Surges

Published May 5, 2021
Clinicians and hospitals can utilize these key strategies to conserve and extend oxygen and other critical supplies for respiratory support, both for general use and during public health emergencies such as COVID-19.

Read the article

Oxygen Conservation Strategies During COVID-19 Surges infographic — Click image to view larger

Lung Transplantation for Patients with COVID-19

Published April 26, 2021
Find practical tips for referring providers, including which patients are viable candidates, when to refer, and what information you'll need to provide to the transplant center.

Download and print (PDF)

Lung Transplant for COVID-19 infographic — Click image to view larger

Delirium

Published March 16, 2021
Prompt recognition of delirium is important to reduce modifiable risk factors and start treatment. Find out what screening tools are available, risk factors, and treatment options.

Download and print (PDF)

Delirium infographic — Click image to view larger

Hypoxemic Respiratory Failure

Published February 18, 2021
Acute respiratory failure is one of the most common reasons for admission to the intensive care unit. Learn about the underlying physiology of hypoxemic respiratory failure, the different types, and the causes.

Download and print (PDF)

Hypoxemic Respiratory Failure infographic — Click image to view larger

Multisystem Inflammatory Syndrome in Children

Published February 15, 2021
A multisystem inflammatory syndrome may cause critical illness in children and young adults up to 2-4 weeks following a SARS-CoV-2 infection. Learn about the clinical presentation, diagnostic criteria, and commonly used treatments.

Download and print (PDF)

Pediatric Multisystem Inflammatory Syndrome infographic — Click image to view larger

A Very Basic Approach to Blood Gas Analysis

Published February 15, 2021
Blood gas interpretation is something that can be difficult to understand but is essential to know when caring for patients in the ICU. In this overview, CHEST presents a simple method for blood gas interpretation that will provide a basic foundation of understanding..

Download and print (PDF)

Questions About the Moderna and Pfizer mRNA COVID-19 Vaccines

Published February 9, 2021
Find answers to several commonly asked questions about the mRNA COVID-19 vaccines.

Read the FAQs

FAQs about COVID-19 vaccines — Click image to view larger

Acute Respiratory Distress Syndrome

Published February 1, 2021
Get a quick overview of the clinical features of ARDS, its pathophysiology, diagnosis, and treatment strategies.

Download and print (PDF)

Acute Respiratory Distress Syndrome infographic — Click image to view larger

COVID-19: ICU for the Non-Intensivist

Updated January 13, 2021; originally published May 6, 2020
CHEST has created a handy, quick reference sheet detailing critical care procedures for non-intensivists who are tasked to take care of ICU patients during the COVID-19 pandemic. The document includes tips on infection control; an overview of COVID-19-specific medications; guidance on managing respiratory, cardiac, hematologic, and neurological manifestations; and more.

Download and print (PDF) Download and print (PDF)

COVID-19: ICU for the non-intensivist — Click image to view larger

Living With Someone With COVID-19: Providing Support While Protecting Yourself

Published December 30, 2020
Caring for someone infected with COVID-19 poses unique challenges for family, friends, and roommates. This infographic provides caregivers with simple instructions on how to cover basic needs, when to seek medical attention, good hygiene practices, how to limit contact, and more. Share with your patients and their caregivers.

Download and print (PDF)

Living with Someone with COVID-19 infographic — Click image to view larger

Acute Kidney Injury

Published November 16, 2020
Critically ill patients with severe COVID-19 may be at risk of acute kidney injury (AKI). Get an overview of the causes and classification of AKI, diagnosis and management strategies, and indications for renal replacement therapy.

Download and print (PDF)

Prone Positioning in Hypoxemic Respiratory Failure

Published November 5, 2020
Prone positioning may be utilized for patients in hypoxemic respiratory failure. Learn about possible positions, physiology, clinical data, and practical considerations.

Download and print (PDF)

Prone positioning in hypoxemic respiratory failure infographic — Click image to view larger

Cytokine Storm in COVID-19

Published October 28, 2020
CHEST offers updates on the role of cytokines in COVID-19 disease and presents the most recent evidence on the use of tocilizumab in the treatment of COVID-19.

Download and print (PDF)

Cytokine Storm and COVID-19 — Click image to view larger

Sleep Telehealth During the COVID-19 Pandemic

Published October 22, 2020
With the onset of the COVID-19 pandemic, the Centers for Medicare & Medicaid Services issued broad authorization to reimburse physicians for telemedicine. CHEST's Sleep Medicine Network provides information on telediagnostics, teleconsultation, teletherapy, and telemonitoring.

Download and print (PDF)

Sleep Telehealth During the COVID-19 Pandemic infographic — Click image to view larger

Shock in Critically Ill Patients

Published August 24, 2020
Shock is common in critically ill patients. Learn about the different types of shock, the associated clinical findings and physiology, and treatments for each type.

Download and print (PDF)

Shock infographic — Click image to view larger

COVID-19 Neurocritical Care

Published August 10, 2020
COVID-19 may lead to a wide spectrum of neurological complications. Learn about the associated clinical findings, phases, diagnostic considerations, and outcomes.

Download and print (PDF)

COVID-19 Neurocritical Care — Click image to view larger

Personnel During Code Blue in the COVID-19 Pandemic

Published August 5, 2020
The COVID-19 pandemic poses unique issues for resuscitation in the event of a code blue. Specifically, it is important to manage the code blue with an eye to the safety of care providers. CHEST proposes an algorithm for managing resuscitation work and personnel flow to simultaneously provide optimum support for patients and optimum protection for caregivers. This workflow was proposed by Michael Waxman, MD, of Kansas City, MO, in accordance with American Heart Association guidelines.

Download and print (PDF)

Personnel during COVID-19 pandemic infographic — Click image to view larger

Management of Patients with COVID-19 Infection

Updated July 28, 2020; originally published March 11, 2020
In this brief article, Ryan C. Maves, MD, FCCP, and Vikram Mukherjee, MD, describe known factors related to the transmission of COVID-19, its epidemiologic and clinical factors, and guidance on patient management and the protection of health-care workers.

COVID-19 Clinical Summary

Published April 3, 2020
Access this evidence-based overview of current patient management strategies and factors.

ICU Administration

Operational Strategies for Mass Critical Care

Published September 17, 2021
The journal CHEST^® recently published an important update to the 2014 consensus statement by the Task Force for Mass Critical Care on providing mass critical care utilizing research gained through experiencing the COVID-19 pandemic. The suggested operational strategies fall within four critical areas: Staffing, load balancing, communication, and technology.

Download and print (PDF)

Operational Strategies for Mass Critical Care infographic — Click image to view larger

Communication in Crisis

Published October 16, 2020
During the COVID-19 pandemic, clear communication between members of the health-care team is crucial. Follow these tips for how to effectively communicate in times of crisis.

Download and print (PDF)

Crisis in Communications infographic — Click image to view larger

Updated Recommendations for COVID-19 PPE

Updated October 13, 2020; originally published March 30, 2020
This handy infographic displays updated PPE recommendations for usage with patients who test positive or are suspected positive for COVID-19.

Download and print (PDF)

Updated Recommendations for COVID-19 PPE — Click image to view larger

How Simulation Can Effectively Prepare Staff for Optimal Patient Care and Minimal Viral Spread During COVID-19

Published August 26, 2020
Simulation exercises can provide a reliable way to optimize patient care and minimize viral exposure, while accommodating the needs of learners and clinicians. Sanjana Mathur, MD, explains how some institutions have utilized simulation during the COVID-19 pandemic.

Indicators and Triggers for Potential Movement to Crisis Care

Updated July 17, 2020; originally published March 19, 2020
John L. Hick, MD; and Dan Hanfling, MD provide a refresher on transition to crisis care standards of care, often necessitated in pandemics, and offers strategies to employ in particular situations.

Surge Priority Planning COVID-19: Critical Care Staffing and Nursing Considerations

Published March 19, 2020
This article by Anne Marie Martland, MS, ACNP-BC, Meredith Huffines, MS, BA, RN, and Kiersten Henry, DNP, ACNP-BC, addresses nursing leadership and administrative considerations, strategies for optimizing staffing resources, and maintaining staff safety and resilience.

Procedures/Tests

Basics of Waveform Capnography

Published May 11, 2021
Managing ventilated patients in the ICU with or without COVID-19 can be challenging. Waveform capnography is a widely used tool to assess ventilation by monitoring exhaled carbon dioxide. Understanding the morphology of different phases of the respiratory cycle in waveform capnography can help clinicians uncover pathophysiology and manage these critically ill patients.

Download and print (PDF)

Capnography infographic — Click image to view larger

Common Diagnostic Tests Used for SARS-CoV-2 Infection

Published March 23, 2021
Access a concise overview of the molecular, antigen, and antibody tests available to diagnose infection with SARS-CoV-2. Differentiate between each test's sensitivity, specificity, pros, and cons.

Download and print (PDF)

Noninvasive Ventilation infographic — Click image to view larger

Extracorporeal Membrane Oxygenation (ECMO)

Published March 16, 2021
Extracorporeal membrane oxygenation (ECMO) may be utilized to support patients with pulmonary and/or cardiovascular failure. Get an overview of ECMO goals, parameters, potential complications, and more.

Download and print (PDF)

Noninvasive Ventilation

Published February 1, 2021
Noninvasive ventilation, or assisted breathing using positive pressure delivered by a nasal, mask, or helmet interface, is increasingly used in the critical care setting to support impending respiratory failure. This infographic outlines the key concepts related to noninvasive ventilation.

Download and print (PDF)

Performing Percutaneous Tracheostomy in a Viral Pandemic

Published November 3, 2020
In this new infographic from CHEST's Bronchoscopy Domain Task Force, learn about patient selection, necessary equipment and personnel, steps of the procedure, and posttracheostomy care during the COVID-19 pandemic.

Download and print (PDF)

Bronchoscopy during COVID infographic — Click image to view larger

Bronchoscopy in the Era of COVID-19

Published October 20, 2020
CHEST's Bronchoscopy Domain Task Force has created an infographic with key information on how to provide timely care while minimizing exposures during bronchoscopy in the era of COVID-19. Get information on indications, recommendations for testing, and tips for performing bronchoscopy in suspected or COVID-19-positive patients as well as COVID-19-negative patients.

Download and print (PDF)

The Intensivists’ Dilemma: Extra-Step or No-Step for Extracorporeal Support in Patients With COVID-19

Published September 1, 2020
COVID-19 has magnified ethical and clinical dilemmas in the ICU. Determining whether it is appropriate to cannulate a patient and start extracorporeal membrane oxygenation (ECMO) needs to be carefully weighed against the availability of resources, team support, and the patient’s goals of care.

Pleural Drainage During COVID-19

Published June 18, 2020
Learn how to create a closed pleural drainage system using stocked items with these step-by-step instructions from Swedish Medical Center in Seattle, WA.

Focused Lung and Cardiac Ultrasound Exams in COVID-19 Patients

Published May 5, 2020
A daily lung and cardiac ultrasound exam is performed on COVID-19 patients. Four lung zones that roughly correspond with the upper, middle (or lingula), and lower lobes are examined on the anterior, lateral, and posterior chest walls, respectively. The lung findings are coded with the highest number in each zone as normal (0), discrete B-lines (1), fused B-lines (2), subpleural consolidations (3), or lobar consolidation (4). At least one cardiac view, usually the parasternal long-axis view, is obtained daily to assess left ventricular systolic function. Any suspected abnormal findings warrant obtaining additional cardiac views for further investigation. The summary of findings sheet (page 2) can be laminated, placed in the patient’s room, and updated daily. The daily exam tracking sheet (page 3) is for clinicians to keep track of their patients’ findings while rounding.

Ultrasound Cleaning Protocol

Published May 4, 2020
View general procedures for the cleaning and disinfection of ultrasound equipment.

Download and print (PDF)

Ultrasound cleaning infographic — Click image to view larger

Airway Management

Published April 9, 2020
All three documents provide consensus expert opinion from the CHEST Difficult Airway Management faculty members for teams conducting emergency airway management (endotracheal intubation) for suspected or confirmed COVID-19 patients. These documents are adapted from the Difficult Airway Management course materials, highlighting considerations in balancing effectiveness and safety of the procedure for patients and the health-care team.

CHEST Emergent Airway Management for Suspected or Confirmed COVID-19 Patients: Provides equipment, personnel, and planning considerations for ICU and airway team leaders who are planning for or engaged in airway management of COVID-19 patients.

CHEST APPROACH to Airway Management- COVID-19 Highlights: Adapts the CHEST APPROACH framework for difficult airway management with key considerations for procedural safety in the COVID-19 setting. Airway teams can use the APPROACH framework to create a shared mental model of the procedure.

CHEST Airway Checklist with APPROACH with COVID-19 Highlights: A companion checklist for the CHEST APPROACH framework for difficult airway management. A team member positioned outside of the room can manage the checklist to support the team's ability to be prepared and maintain situational awareness.

COVID-19 Precautions During Airway Management

Published March 31, 2020
Download this helpful guide for clinicians on COVID-19 precautions during airway management.

Supply Chain

Essential Institutional Supply Chain Management in the Setting of COVID-19

Published March 19, 2020
As the COVID-19 pandemic evolves, supply chain disruptions for medical supplies and medications are anticipated. Pritish K. Tosh, MD; and Lisa Burry, PharmD, discuss how health-care facilities can examine and optimize their supply chain management in order to detect and respond to supply chain disruptions.

Treatment

Monoclonal Antibodies for Treating Patients With COVID-19

Published December 6, 2021
These investigational medications—approved for emergency use in patients by the FDA—may reduce progression to severe disease and shorten recovery in high-risk patients. Understand the types of monoclonal antibodies currently available in the US, indications for use, mechanisms of action, and NIH guidelines for this therapy.

Supported by Regeneron

Download and print (PDF)

Immunomodulators Infographic — Click image to view larger

Antimicrobial Stewardship and COVID-19

Published July 23, 2021
Antimicrobial stewardship helps improve patient care by optimizing antibiotic use, minimizing broad-spectrum antibiotics, and decreasing antimicrobial resistance. This infographic is a handy reference on the challenges of antimicrobial stewardship in COVID-19, signs of co-infection, principles of antimicrobial treatment, and more.

Download and print (PDF)

Immune Modulation for Infections Including COVID-19

Published March 3, 2021
Viral sepsis, and COVID-19 viral sepsis in particular, provokes a dysregulated immune response. Multiple immune-modulating medications have been used and studied in the treatment of patients with severe critical illness and dysregulated immune response. Understand the mechanisms, physiology, and research behind each of these therapies.

Download and print (PDF)

Antimicrobial Stewardship & COVID-19 infographic — Click image to view larger

Monoclonal Antibody Therapy for COVID-19

Published January 20, 2021
High-risk outpatients with COVID-19 may benefit from receiving monoclonal antibodies. This therapy may reduce the need for hospitalization. Learn more about indications, contraindications, what the research says, and administration.

Download and print (PDF)

Monoclonal Antibody Therapy for COVID-19 infographic — Click image to view larger

Currently Available and Emerging Therapies for COVID-19

Updated August 14, 2020; originally published March 30, 2020
Authors Kelly M. Pennington, MD; and Eva M. Carmona, MD, write about therapies and medications currently in use or under trial for the treatment of patients with COVID-19.

ADDITIONAL RESOURCES

World Health Organization (WHO)
WHO offers international guidance on the COVID-19 pandemic, including situation reports, research updates, and strategic preparedness information.

Centers for Disease Control and Prevention (CDC)
The CDC’s COVID-19 webpage for health-care professionals features information on clinical care, infection control, staff training, and more.

National Center for Biotechnology Information SARS-CoV-2 Resources
Access a comprehensive database of COVID-19 literature, SARS-CoV-2 sequence resources, information on clinical trials, and more.

Johns Hopkins University COVID-19 Case Tracker
This dashboard from the Johns Hopkins University Center for Systems Science and Engineering provides a regularly updated map of confirmed COVID-19 cases and deaths around the world.